Provider Demographics
NPI:1740093178
Name:MUDGE, SUZANNE (LPC-S)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:MUDGE
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11203 HUNTERS BREAK
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4254
Mailing Address - Country:US
Mailing Address - Phone:210-391-5066
Mailing Address - Fax:
Practice Address - Street 1:325 E SONTERRA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4056
Practice Address - Country:US
Practice Address - Phone:210-391-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health